"They didn't teach that to me in medical school (back in 1980)!"

Unfortunately vitamin d is not mentioned in med school nowadays except for osteoporosis prevention...

Dr. Davis -- thank you for your blog. I am a med student interested in REAL evidence based medicine (which makes me a bit unpopular between my teachers).

I researched vitamin D after reading your blog, and decided to mega-dose on it. It's been 4 weeks now and my "inespecified mood disorder" (never met criteria for depression, but have never been really "well" since I was 16) is GONE. Like a "veil" has fallen or something. PMS is gone as well.Now I have discovered that the periods of my life in which I felt truly well were when I spent outside most of the day (I live in the mediterranean coast).

I also had a single attack of MS some years ago, so vitamin D will help to prevent full blown multiple sclerosis.

My comment is in no way related with atherosclerosis, but I just wanted to thank you, and congratulate you for having found a way to help people outside conventional medicine. I feel greatly inspired by your work.

Regards,

Angela Nicolas

"primary care physicians are completely in the dark"

For the record, we aren't ALL in the dark. In fact, I stumbled across your website a few years ago as I was looking for supportive testimony from other practitioners who saw things clearly. In fact, I watched as you "caught up" with the idea of adding Vitamin K2 to your regimen - presumably based on the results of the 2004 Rotterdam Study.

I hate to sound defensive, but such a sweeping generalization is uncharacteristically irrational of your posts up to now. Perhaps you haven't known any primary care "grunts" without a cranial suppository.

Now you know at least one.

I guess it's just a matter of time until someone breaks the record again?

I know you have talked highly of vitamin K2, I'm wondering if you've made it a staple of the TYP program already? I think there's all reason to do so.
Below two studies using high doses of K1, but it should work via conversion to K2 (the epidemiology of K2 hints at the same phenomenon).

Am J Clin Nutr. 2009 Apr 22. [Epub ahead of print]
Vitamin K supplementation and progression of coronary artery calcium in older men and women.
Shea MK, O'Donnell CJ, Hoffmann U, Dallal GE, Dawson-Hughes B, Ordovas JM, Price PA, Williamson MK, Booth SL.

One of THE most impressive studies I've ever read:
Thromb Haemost. 2004 Feb;91(2):373-80.
Beneficial effects of vitamins D and K on the elastic properties of the vessel wall in postmenopausal women: a follow-up study.
Braam LA, Hoeks AP, Brouns F, Hamulyák K, Gerichhausen MJ, Vermeer C.

Over the last year, I have seen about a dozen physicians (for a reason other than heart disease).

Be they a GP, cardiologist, pulmonologist, oncologist, or hematologist, they all tell me the same thing; we all "naturally" develop coronary plague as we age and that it can only be minimally "managed" by lowering our cholesterol with -insert your statin drug here.

Every time I reply with; there is nothing natural about having calcified plaque build up in our coronary arteries at any age and that it can be very effectively managed by following Dr. Davis' "Track Your Plaque" protocol. (As I pull out your book to show them.)

The physician then usually looks at me like I have two heads and dismisses me by standing up to signal that the visit is over.  Except for one physician, honestly, who responded by reaching for his script pad and saying that he would like to start me on an antidepressant medication right away... lmao.

I have now given up looking for any local physician who would be willing to help me in any way with the heart scan/track-your-plaque program.

Antidrugrep--

Actually, that generalization was intended principally for the sorts of primary care docs who wouldn't read a blog like this. You are clearly the exception.

If you had responded that most cardiologists are knuckleheads out for a buck, I would have agreed, too.

Kismet--

Thanks for the references. I hadn't seen the Shea study; the findings are interesting.

We haven't had enough people have pre-K2 and post-K2 heart scans, so it's hard to know what effect it ADDS to the existing battery of strategies. Nonetheless, K2 is definitely on the list of most promising. Given its benign nature, I do encourage people to add it, though dosing remains entirely uncertain.

I seem to be developing atherosclerosis at age 26 and I've been doing a lot of research. B12 and Vitamin D are related, but you should also be aware of magnesium. See the study at Comparison of Mechanism and Functional Effects of Magnesium and Statin Pharmaceuticals. In this study they basically explain how magnesium works as a natural statin and calcium channel blocker. If you do further research online you may become convinced, as I am, that magnesium deficiency is just as widespread as Vitamin D deficiency.

You need to take a chelated form of magnesium, such as glycinate, because other forms (like magnesium oxide) are poorly absorbed by the body and not worth the money.

I would predict that the cardiologist is among the conventionally-thinking, "statins drugs are the only solution" group who follows his patients over the years to determine when a procedure is finally "needed." In fact, I know many of these cardiologists personally. The primary care physicians are completely in the dark, usually expressing an attitude of helplessness and submitting to the "wisdom" of their cardiology consultants.

Worst thing you can do is use the tobacco drug, either by smoking or through spit tobacco.

Also, being exposed to toxic tobacco smoke (sometimes called second-hand or environmental tobacco smoke) is EXTREMELY Dangerous! Make sure you work to BAN SMOKING EVERYWHERE, INDOORS OR OUT!

Better yet, BAN THE TOBACCO DRUG, NOW!

Just getting around to reading some of your older blog posts.

Although I'm not completely certain, it's my impression that Marcovina was a student of Professor Sally McCormick of Otago University in New Zealand.

http://biochem.otago.ac.nz/staff/mccormick/smccormick.html

Notice they both participated in this seminal article.

Sharp RH, Perugini MA, Marcovina SM, McCormick SPA: Structural features of apolipoprotein B synthetic peptides that inhibit lipoprotein(a) assembly. J Lipid Res 45:2227-2234, 2004.

I'm very certain that Rebeca Sharp was a student at Otago.

More importantly, Sally McCormick has applied for a patent mirroring the article title linked to above at wipo.int.  Don't have the link handy.

Many of the non distilled forms of Fish oil seem to specify varying amounts of cholesterol contamination , + saturated fat etc.  In the pharmaceutical or distilled types most of the fat content is accounted for by the omega-3 content while in most over the counter types you will find varying amounts of additional fat and cholesterol specified. (Nature Made for example has the following:
Per 2 Softgels: Calories 25 (Calories From Fat 20); Total Fat 2.5 g (Saturated Fat 1 g; Polyunsaturated Fat 1 g; Monounsaturated Fat 0.5 g); Cholesterol 25 mg; Protein 2 g; Fish Oil Concentrate 2400 mg (Omega-3 [EPA] Eicosapentaenoic Acid 360 mg; Omega-3 [DHA] Docosahexaenoic Acid 240 mg); Gelatin (Non-Bovine); Glycerin; Water; Tocopherol.

Will insurers cover Omacor?  I don't know...

If so, I know a number of people who would go get a script today.  The out-of-pocket costs for supplements just aren't in some people's budgets.  But I agree with you, it's a shame the system is designed to support such blatant profit for so few people.

Omacor is a prescription drug and it is covered by my insurance. I pay $90 for a three-month supply, that is four capsules a day for a total of 360 capsule. It is also covered by my flexible spending account, so that saves me about 30% tax. I effectively pay about $63 for three months. So the cost per capsule is about 17.5 cents.

Don't kid yourself:

You may pay $63 for a prescription out of pocket, but you and society pay a far larger price of $240 per month through increased health insurance costs. All of us ultimately bear the higher price. In this instance, all the excess profits go into Omacor's pockets, thanks to the brainwashing of the public and physicians.

Its amazing that Physicians, who lead their life using medicines and treatment protocols which are based on clinical research, discourage the use of the only truely clinically proven, regulated, prescription Omega 3 acid available.  The benefits of this product extend far past its triglyceride lowering effects, which makes it a product that should be considered for positive health as well as disease treatment.  The clinical studies are horrifically expensive, a natural based product is unpatentable, therefore making whomever is willing to put millions of dollars into making sure the clinical background is well tested, take a large risk. Copycat, unproven, dietary supplements (by the way which are monitored by the same people who monitor kit kats and gatoraid)make unsubstantiated claims. Shouldn't the developers and companies of this pharmaceutical product be  repaid, profit, and also be supported enough to continue the clinical research and development of such products.  If only the worlds medications were made up of more natural based solutions I believe we would be much more satisfied and less at risk of side effects from strictly chemically "isolated" molecules.  Omacor (which is now Lovaza) provides a glimpse of what practitioners have been looking for, a natural based prescription medication, effective, clinically proven to lower triglycerides similarly to other available therapies (with less expected drug to drug interactions or adverse events) and controlled so it is easier to recommend and use by health care professionals.  What is the sociatal cost of frequent LFT's, myopathy, rhabdo, Drug to Drug interactions from 145 fenofibrate?  Not the POOLED representation of Adverse events in the PI, that my good Doctor is trickery.  The 48mg might be more innocuous, but the 145mg is still risky and even recently had many other interactions and warnings added.  That is still considered a good drug, effective, possibly safer than the alternative of no treatment, but it does say to mind the "risk benefit ratio" which is thrown to hell when products like Omacor (Lovaza) come to market proven to work without expected side effects.  You might want to rethink how you see the companies and industries that develop the future of medicine.  No one is perfect, nor totally disclosed, however this product is certainly a step in the right direction and should be supported, not stiffled.

Anonymous--

I think you may have missed the point of the post.

I was not bashing Omacor/Lovaza because it is fish oil. I have been using fish oil for years with excellent results, preparations that work wonderfully and cost around $3 per month.

Now, there's a fish oil that costs $130+ per month? Purer? I would like to see side-by-side comparisons; I have seen no such thing. There are over-the-counter, highly purified preparations available without prescription and for less than a tenth of the cost of Omacor/Lovaza.

I agree that fish oil in some form should precede the use of fibrates like Tricor. I rarely use Tricor, even though much of my cardiology practice has evolved into a lipid consulting practice.

I guess my point is specifically, if you support $3 fish oils and their use, will those companies obediently go out and do the clinical studies that you need to feel secure to treat your patients?  Business and price per product does not come cheap.  The studies done, the missed compounds, the intergration into a patented item, the production, and the standards and guidelines all factor into the price of a product.  I just believe it to not only be unfair to recommend that patients use other than the proven product (unless there is no alternative) but also bad business sense.  If there is not loyalty or ethical appreciation to the developers and testers of these pharmaceutical products, who will then develop medicine?  I believe it would be futile to compare regular fish oil to Lovaza, just as it would be futile to compare most other drugs head to head.  The difference between relative/ actual and clinical vs. theraputic significance is very hard to show.  However, the dosing (4per day vs 8 t0 15 of reg fish oil), the purity (excursions from storage parameters render the compound less or ineffective = lack of controled standards)the purity (many manufactures are continuously being warned from FDA about the consistancy of product) and the lack of attributable cause data linking other less pure concentrations to actual clinical outcomes are all reasons that a seasoned medical professional like yourself should support the use of Lovaza instead of Fish oil capsules whenever possible.  I do know there are studies in europe about dosing regimin vs. clinical lipid results.  I would expect that at 8-15 fish pills per day the outcome results would be similar, however more variation and much more fat and omega 6's per pill.  Compliance would be less than optimal, outcome would be less than optimal, and with any alternative prescription that provides confidence in all variable and clinical aspects, this should be commended and supported whenever possible rather than talking about "brainwashing the public and physicians."  I wish someone would figure out that for every product that is developed, tested, and brought to market there are 20 other products that are in some stage of development and fail to be approved.  If EACH drug that comes to market costs approx $1.2 billion dollars (Tufts CSDD 2006), how much do you think is lost with the other 10-20 drugs that fail to gain approval?  Somewhere between 100 and 500 million PER FAILED DRUG!  Multiply that times the 10-20 that failed and you have approximately  6,000,000,000 (6 billion dollars).  With that said, it takes a lot more than just actual production cost to reimburse for past, present, and future research and development, business expenses, and of course profits to keep the company developing key breakthrough products.  All I am saying is that I understand and commend you for using an agressive alternative therapy addition in your patients to increase their health and hopefully life.  I do however believe that there is a blame game in medicine created or exacerbated by insurance companies that leads to finger pointing about medical necessity and cost.  People look towards trimming expenses in all places, however if drugs like Lovaza (not just fish oils) are not appreciatively embraced by practitioners and supported/ recommended whenever possible, there will be no more drugs or better yet, alternative large scale studies done on this kind of unpatentable compound because physicians assume similarities and switch to a compound like Dietary supplements.  Sorry, Ill step down from my soap box now, however this is definitely a sore spot for me.

Do you work for a pharmaceutical manufacturer?

Is it the same sort of economics that allows the founder/CEO of Kos Pharmaceuticals to cash out for $2.3 billion in personal payout, followed by the company raising the price of Niaspan?

The answer, in my view, is not to gouge the public with extravagant drug prices, but to support non-profit-seeking research.

Dear Dr Davis,

I had to comment on this old blog as I am in the UK. Up until yesterday I was buying omega-3 fish oil from my health food shop, an amount to give me 2250 mg per day, that is 1125 mg EPA and  750 mg DHA, and it was costing me in the region of £25 per month. I have a bicuspid aortic valve with moderate stenosis and talking about omega-3 fish oils with my cardiologist he suggested that I be prescribed Omacor instead. The Omacor is courtesy of the NHS and is therefore free for me ! I'm very happy to have got it

I would love to have some studies, though, which show the positive effect of omega-3s on coronary calcification.

Anne

Anne said, "...my cardiologist...suggested that I be prescribed Omacor...The Omacor is courtesy of the NHS and is therefore free for me ! I'm very happy to have got it ".
I left hospital a month ago with a prescription list that included Omacor but when I visited my NHS GP for a repeat prescription I was told that I could buy this item for myself, over-the-counter. :-(

"If I go to Sam's Club the same quantity of omega-3 fatty acids (in three capsules) will cost around $2.50. That's less than 5% of the cost of the prescription form."

Lovaza capsules contain >80% purified EPA and DHA (465 mg and 375 mg, respectively), which are purified from fish oil.  The other oils are fish oils, and could possibly be omega-3s.  You must take at 2-4 for triglyceride lowering (at least one for CV risk reduction in AVD patients).  

I don't know about any specific manufacturers OTC, but I do know that typical products contain 120mg DHA and 180mg EPA per GRAM of capsule. This means that only 30% have been confirmed to be the beneficial oils.  What else is in there?  This is why Lovaza does not have a fishy aftertaste, but OTC ones do.  Also, look how many you would have to take to equal the DHA and EPA in Lovaza.  It is not ANY fish oil, but specifically DHA and EPA that is necessary for CV benefit.

Alpha linoleic acid MUST BE ACTIVATED to give CV benefits, and humans only activate 10% of alpha linoleic acid, so products claiming to have a ton of omega 3s using this compound are giving their values of omega-3s via a technicality (alpha linoleic acid is "technically" an omega-3).  

This is not to mention the whole issue of herbal/supplement companies basically able to put anything in a capsule as long as it isn't harmful, REGARDLESS of what they say it is.  The FDA just doesn't care to watch these companies much.  

Therefore, if I had the money, I would go Lovaza, but I am a cheap @$$ and would rather go with a USP Verified OTC product and take my chances

Why would the NHS only recommend eating fish and prescription fish oil? I don't know, but it smells awfully fishy to me. As soon as an opportunity for profit is built into a treatment, all of a sudden it gains endorsement. Perhaps lobbying by those parties with potential for profit drove the process.